Provider Demographics
NPI:1992505200
Name:WARREN, KISHA
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:WARREN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 MAXEN DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1030
Mailing Address - Country:US
Mailing Address - Phone:234-303-9410
Mailing Address - Fax:
Practice Address - Street 1:1218 DEAN CT APT 204
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-1737
Practice Address - Country:US
Practice Address - Phone:909-217-9783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant